dr rahul vc tiwari - oral & maxillofacial surgery - sibar institute of dental sciences, gunutr,...
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Oral surgery in liver transplant candidates: a retrospective study on delayed bleedingand other complications
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About the Journal
Journal Name: Oral Surgery, Oral Medicine,
Oral Pathology and Oral
Radiology
Periodicity of journal: Monthly
• Editor in Chief: R Bryan
Bell
• Publisher’s name: Thomas
Reuters Ltd.
• ISSN NO Print : 0265 -539X
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About the Journal contd..
• Impact factor:
• Peer review:
• Indexation:
0.732
Yes
Pubmed, Google scholar,
EBSCO
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• Date of publication: 1st May 2016
• Volume:
121
• Issue: 5
• Type of article: Research
Article
• Page numbers: 490-495
• Received: 25 August 2015
• Accepted: 24 January 2016
About the Article
5
9 months
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About the Article contd..
• Author names :
• Institutional
Attachments :
• Designations :
• Keywords :
Jaana helenius hietala& its associates
Helinski, finland
Not MentionedDental infections,Heamorrhage,Tooth extraction,Liver cirrhosis
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• Study design : Mentioned.
• Common terms : Common terms were
used.
Title :
Oral surgery in liver transplant candidates: a
retrospective study on delayed bleeding and other
complications
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Running Title:
Bleeding following oral surgery in liver transplant candidates
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Abstract:
Informative :
Yes
Balanced summary of what
was done and what was found:
Structured
Abstract.9
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Introduction:
Scientific
background:
Approach:
Mentioned
Seminar approach
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Guggenheimer et al 2003, Helenius heitala j et al 2013
Pre-transplant dental treatment is a prerequisite in many liver transplantation pt.to prevent post-transplant infectious complications, such as bacteremia and sepsis, which could be fatal in immunocompromised patients.
Helenius heitala j et al 2012, ward BB et al 2006
In particular, patients with chronic liver disease (CLD) have shown poor oral health with a high prevalence of dental infections in pre-LT dental evaluations. Patients with CLD also run a high risk of bleeding after oral surgery, due to CLD-associated coagulopathy
Perdigao JP et al 2012, Stanca CM et al 2010
previous studies were limited by small cohorts (9 to 90 patients), and those patients often had well-compensated CLD
Valerian 2007, Hong CH 2012
Earlier studies that specifically studied LT candidates, that is, patients with advanced or end-stage liver disease, included only 23 to 36 patients.
REV
IEW
OF
LITE
RAT
UR
E
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Objectives:
Untreated dental infections pose a threat for immunocompromised
liver transplant (LT) recipients.
Therefore, pretransplant dental evaluations are recommended.
However, risk of bleeding should be considered among patients with
end-stage liver disease and prophylactic blood transfusions may be
used to prevent bleeding.
We retrospectively studied the incidence of and risk factors for oral
surgery-related bleeding in candidates for LT and hypothesized that
complications may occur despite pre- and peri-operative hemostatic
actions.
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Pre-
specified
hypotheses :
Mentioned
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Study design:
One hundred thirty four patients who had tooth extractions
by oral and maxillofacial surgeons pre-LT
were studied.
The primary endpoint was bleeding between 24 h and 2
weeks post-extraction. Bleeding risk was analyzed by the
pre-operative platelet (PLT) count and INR.
Invasiveness of procedures, severity of liver disease, PLT,
INR, prophylactic transfusions of PLT, fresh frozen plasma,
and tranexamic acid (TA) were included in uni- and
multivariate logistic regression analysis to further assess
risk.14
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Sampling technique:
Study design:
Setting Locations:
Relevant dates
Periods of
recruitment:
Statistical analysis:
Statistical test:
Not mentioned
Retrospective study
Helsinki, Finland
2000-2006 (toto of 306- dental evaluation 263 in that 134) = -129?
SPSS.ver.17Chi-square,Mann-Whitney testUnivariate logistic regressionMultivariable logistic regression
Materials and Methods
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Variables:
Dependent: bleeding incidence,
platelet level
Independent: tooth extractions
INR
MELD score
PPT
Age
Gender
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ResultsTwelve patients exhibited minor bleeding; four despite PLT>100x109/L and INR<1.5.
Increased bleeding associated with INR and prophylactic transfusions by univariate analysis;
by multivariate analyses, prophylactic TA and PLT remained significant.
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Discussion
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Given
Limitations:
Overall
interpretation
of results :
Generalizabili
ty:
Mentioned
Given.
Not Discussed.
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Observed Limitations
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• Retrospective
• Only INR & Platelets were considered
• Results partly confirm the hypothesis
• No other complications are mentioned
• Only males
• No reason for age groups
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Bias:
Ethical clearance:
Funding:
Not mentioned
Institutional review board approval from Helinski
Mentioned
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Conclusion is meaningful and is based on aim of the study.i.e risk of bleeding is difficult to predict in patients with cirrhosis but, on the other hand, frequency of delayed bleeding is in general low.
Acknowledgement were not mentioned.Recommendation were not mentioned.
Finally, results suggest that use of prophylactic blood coagulation factors requires individual assessment.
CRITICAL APPRAISAL OF CONCLUSION
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Suggested Title:
26
Delayed bleeding in tooth extraction
males among 45-51 year old with liver
transplant in Helniski : A
Restrospective study.
OR
Retrospective study of delayed
bleeding after tooth extraction in 45-
50 year old age group who underwent
liver transplant in helinski.
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23 references in total.
References accessed were : 14
References are in HARVARD .
Number of articles reflecting the study: 09
Reference before 2006: 10
Reference after 2006: 13
Introduction: 8 were cited
Materials and methods: NONE
Discussion: 15 were cited
CRITICAL APPRAISAL OF REFERENCES
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Statement of clinical relevance
INR and platelet count do not reliably predict bleeding after tooth extractions in liver transplant candidates due to rebalanced hemostasis.
Lisman T et al. 2010 . Rebalanced hemostasis in patients with liver diseases: evidence and clinical consequences.
Hence, routine prophylactic replacement therapy may be ineffective.
Alternatively, local hemostatic measures and close post-operative follow-up by a skilled clinician are recommended.
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